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ORIGINAL STATE OF CALIFORNIA Do not fill in <br /> j THE RESOURCES AGENCY <br /> File with bWR UEPARTMENT OF WATER RESOUR els No, 060029 <br /> ( of Intent No, 148156 WATER WELL DRILLERS REPORT slide Well No. <br /> , permit Nn. or Ditto 78 _ 1581 Other Well Nn, tJ <br /> ( 1 ) OWNER : Nnn, Del Auch Con $ ' t , ( 12 ) WELL LOCI Total do th /Jp <br /> 1369 Lincoln Blrtd . R. Depth of completed well LS(_fro <br /> AAAresx from It, to It. Fam,ntion ( Describe by whir, character, size or material ) <br /> cay .. Trac V, ra 11 f _zipqqI76 – <br /> ( 2 ) LOCATION OF WELL 0 - 3 fine ran <br /> n�oaqui ( See wner's ellN <br /> coaatv_ d n Owner's Well No:,,ner 3 - 7 sandstone., <br /> Well address if different frons above 7 - 12 $ 0 t row ay <br /> Township—. Ranee - Seedn – rd r C ' <br /> utstm,ee from cities, mad,, railroads, lances, ate._ - o a d and swat 1 rock . <br /> 52 ra <br /> 52 - 60 < ourse ` 4and and small rock <br /> 60 - 80 Sat qrM clay tree rootssm , roc <br /> ( 3 ) TYPE OF WORK, <br /> New Well (X Deepening ❑ •% �� <br /> Reconstruction ❑ <br /> bllflt � Reconditioning El <br /> o <br /> Horizontal Well ❑ <br /> 1Pv Destruction ❑ (Describe <br /> destruction maton <br /> procedures in item 1Z _ <br /> 3 ( 4 ) PROPOSED <br /> v y Domestic <br /> Irrigation ❑ _ <br /> Industrial ❑ - _ -' <br /> Test Well ❑ _ <br /> Stock ❑. _ <br /> Municipal Q – <br /> WELL LOCATION SKETCH Other ❑ – <br /> ( S ) EQUIPMENT: ( 8 ) GRAVEL PACK, _ <br /> Rotary 91 Reverse ❑ Yes ] No ❑ Sbor Ii – <br /> Cnhle ❑ Air ❑ Diameter of bbe�e7rlays jail <br /> Other ❑ Bracket ❑ Packed from,.Ily. to—g�_ft: – <br /> ( 7 ) CASING INSTAALLED, ( 8 ) PERFORATIONS: – <br /> Steel ❑ Plastic (ayConcrete ❑ Type of perforation or size of screen - – <br /> Fmm <br /> To - Din. Gnge'or From - To Slot <br /> f[. ft. - in, Wall ft. ' ft. . -size ' _ <br /> 61 kill 61 1 tq P 4 ,16 X 20 - <br /> ( 8 ) WELL SEAL: <br /> Was surface sanitary send provided? Yes No ❑ if yes, to depth--60_ft. - <br /> %Yom strati[ .wiled against pollution? Yes ❑ NX Ex Interval It, _ <br /> Method of sealing henti note 1CCIP3@Ilt mix Work started 19 Complet lfl <br /> ( IO ) WATER LEVELS: WELL DRILLER'S STATEMENT: <br /> Depth of Hut water, if knew it. This luelf was drilled unde my for (diction d this report is taw to the best o/ my <br /> . Standing level after well completion R. knmolydga n belie/. <br /> ( 11 ) WELL TESTS : SIGNen GtII"I <br /> \Vas well test made? Yes J( ;No ❑ If ver, by wham? ( Wqq Driller ) <br /> Type of test Pump ❑ Bailer ❑ Air lift Mr NAME Canada Pump SMes and Service Inc . <br /> Depth to t shod of test it, At end of test ft ( Person, Bms, or corporation ) (Typed or printed) <br /> Dhenarae mnun after hours Water te,nperawa Address . P . B . Box QQO <br /> .111 am:iysie made? Yes n No If yes, by whmn' Icity A11t1 nch . f a 1 i f . zipg4.5D9 <br /> has electric hat made? Yes ❑ Nn If Yes. attach copy to this report License No. 347RQl Date of this roper <br /> DWR tell : REV. 7. 701 IF ADDITIONAL SPACE IS NEEDED, USE NEXT CONSECUTIVELY NUMBERED FORM <br />